Canada is due for major debate on medicare: Romanow

The lack of pre-election chatter on medicare is the calm before the storm, says former Saskatchewan premier Roy Romanow.

The country’s pre-eminent torchbearer for a social policy so cherished it’s often described as a part of Canada’s national identity predicts a coming values war over the privatization of medical services in a speech Friday.

“We may be heading for a major – I was going to use the word apocalyptic but that’s probably too dramatic – battle about the values and principles of private versus public health care,” said Romanow, speaking to the Broadbent Institute’s annual Progress Summit in Ottawa.

The chair of the 2002-2003 Royal Commission on the Future of Health Care bemoaned the lackadaisical attitude politicians have taken toward national health care, especially federal Health Minister Rona Ambrose.

“The minister of health seems to be missing in action,” he said.

Romanow, who was received warmly by the country’s largest gathering of progressives, pegged his dissatisfaction on the number of deviations from the principles of the Canada Health Act taking place today.

He contrasted the lack of a sense of urgency with the head-on approach the Trudeau government took in 1984 when creating the Canada Health Act, an initiative meant to fill the holes in national medicare that had appeared since its introduction in 1966, he said.

“In most recent years, Ottawa has become more reluctant to involve itself in the shaping of new national reforms,” said Romanow. “They’ve forgotten to enforce the Canada Health Act at all.”

Discussion over major reforms of Canada’s universal health care program has fallen by the wayside since the Conservatives came to power in 2006, a party that has preferred to let the provinces run health care on their own while the tightening federal transfers to their governments on which the national system is premised.

The government has invested in information technology and innovation in the health sector, but there’s little evidence that’s led to a climate of reform in provincial capitals, according to one of Canada’s most well-known academics in health policy.

“The sad news is actually that there’s very little other than the most incremental reform going on in the country,” said Greg Marchildon, a University of Saskatchewan professor who runs a monitor on health reform. Marchildon chaired a panel discussion following Romanow’s speech at the summit.

As public health systems and industries have proliferated across the globe since Canada established itself among the health policy vanguard of developed nations decades ago, Romanow agreed there are risks today in taking health care for granted given the exponential growth in the sophistication of health services.

“We’ll see a disparity amongst the regions,” he said. “There’s a pretty high price today for doing nothing. This is a country that is fragile in many ways.”

Romanow, who governed as a New Democrat but held his position as chair of the royal commission as an appointment under a Liberal government, called for the Conservatives’ approach to be replaced with a return to “cooperative federalism.”

“We have built this country on the basis of charity,” he said. “Doing nothing..amplifies the regional disparities that exist which is wrong as a country.”

Romanow offered his ideas for reform in his speech: universal pharmacare; a national mental health strategy; a plan to address upstream determinants of health; more money for innovation; the return of an evaluation body like the kiboshed Health Council of Canada; and a stronger enforcement push by Ottawa to ensure the Canada Health Act is followed.

He gave particular prominence to universal pharmacare, long considered a natural handmaiden to medicare. In the past month, studies have argued for the cost-saving effects of a national drug plan. Ottawa appears poised to join a provincial and territorial effort to buy drugs in bulk.

The federal government should use its many powers over the drug market — safety, patent regulation and even advertising rules — as leverage to create a plan for universal coverage, a much bolder move than the bulk purchasing currently on the table.

“This is one area of health care where the federal government has a major constitutional foothold,” he said.